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Insulin-deficient Diabetes. Current Care Guideline.
Abstract
About 500,000 people suffer from diabetes in Finland, a number which is predicted to increase within the next decades. At the moment, diabetes can neither be prevented nor cured. Diabetes is associated with microvascular (kidney, eye and peripheral nerves) and macrovascular complications (coronary heart disease, stroke). These complications affect the quality of life of patients and account for a substantial proportion of healthcare costs in Finland. The current guidelines offer recommendations for the diagnosis, screening, prevention and treatment of diabetes and its complications.
The current update provides a partly separate recommendation regarding insulin-deficient diabetes (including type 1 diabetes, secondary diabetes and genetic forms of diabetes).
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Objectives-This study aimed to examine the relationship between self-reported oral health, oral hygiene practices, and oral human papillomavirus (HPV) infection among women at risk for sexually transmitted infections in Ho Chi Minh City, Vietnam. Study design-Convenience and referral sampling methods were used in a clinic-based setting to recruit 126 women aged 18-45 years between August-October 2013. Behavioral factors were self-reported. Oral-rinse samples were tested for HPV DNA of two low-risk and 13 high-risk genotypes. Results-A higher unadjusted prevalence of oral HPV infection was associated with poorer self-rated overall oral health (p=.001), reporting oral lesions/problems in the past year (p=.001), and reporting a tooth loss not because of injury (p=.001). Higher unadjusted prevalence of oral HPV infection was also associated with two measures of oral hygiene: lower frequencies of toothbrush per day (p=.047) and gargling without toothbrush (p=.037). After adjusting for other factors in multivariable logistic regression models, poorer self-rated overall oral health remained statistically associated with oral HPV infection (p=.042); yet, the frequency of toothbrush per day did not (p=. 704). Conclusion-Results corroborate the association between self-reported poor oral health and oral HPV infection. The effect of oral hygiene on oral HPV infection remains inconclusive.
Background Diabetes mellitus is a strong risk factor for cardiovascular and renal disease. We investigated whether the angiotensin-converting-enzyme (ACE) inhibitor ramipril can lower these risks in patients with diabetes. Methods 3577 people with diabetes included in the Heart Outcomes Prevention Evaluation study, aged 55 years or older, who had a previous cardiovascular event or at least one other cardiovascular risk factor, no clinical proteinuria, heart failure, or low ejection fraction, and who were not taking ACE inhibitors, were randomly assigned ramipril (10 mg/day) or placebo, and Vitamin E or placebo, according to a two-by-two factorial design. The combined primary outcome was myocardial infarction, stroke, or cardiovascular death. Overt nephropathy was a main outcome in a substudy. Findings The study was stopped 6 months early (after 4.5 years) by the independent data safety and monitoring board because of a consistent benefit of ramipril compared with placebo. Ramipril lowered the risk of the combined primary outcome by 25% (95% CI 12-36, p=0.0004), myocardial infarction by 22% (6-36), stroke by 33% (10-50), cardiovascular death by 37% (21-51), total mortality by 24% (8-37), revascularisation by 17% (2-30), and overt nephropathy by 24% (3-40, p=0.027). After adjustment for the changes in systolic (2.4 mm Hg) and diastolic (1.0 mm Hg) brood pressures, ramipril stilt lowered the risk of the combined primary outcome by 25% (12-36, p=0.0004). Interpretation Ramipril was beneficial for cardiovascular events and overt nephropathy in people with diabetes. The cardiovascular benefit was greater than that attributable to the decrease in blood pressure. This treatment represents a vasculoprotective and renoprotective effect for people with diabetes.
To study the frequency of diabetic retinopathy in relation to age at diagnosis, treatment, duration of diabetes and glycemic control as measured by means of HbA1c levels, we performed a cross-sectional, registered-based study in the Helsingborg area of southern Sweden, comprising 2232 diabetic patients. Of the known diabetic population < 75 years old, approximately 70% were estimated to be included. We graded retinopathy according to the alternative classification of the Wisconsin study. With an age at diagnosis < 30 years (19% of patients) the prevalence of retinopathy was 64%, whereas with an age at diagnosis > or = 30 years the prevalence of retinopathy was 57% in insulin-treated, and 26% in non-insulin treated patients. Levels of glycated hemoglobin and duration of diabetes were associated with retinopathy in the group with younger onset. In the older-onset group, there was a relationship between retinopathy and duration of diabetes and insulin treatment; glycated hemoglobin had a relationship which was of borderline significance with any retinopathy, but clearly significant with the pooled group: severe non-proliferative, proliferative retinopathy and/or macular edema. Hyperglycemia and duration of diabetes were thus associated with retinopathy in both younger- and older-onset diabetes, but hyperglycemia less so in the older-onset group.
AIM, BACKGROUND: The aim of this study was to assess the degree of marginal alveolar bone loss in a group of young subjects with type 1 diabetes mellitus (DM) (n=35, age range 24-36 years) and age-matched non-diabetic control subjects (n=10).
The diabetic group was divided into 3 subgroups (D1, D2, D3) according to the severity of the diabetic state. The level of alveolar bone was measured on panoramic radiographs of maxillary and mandibular molars as the % of the distance between the cemento-enamel junction (CEJ) and the bone crest along the total length of the root. All mesial and distal sites with a distance of > 15% (BL>15%) were picked, and calculations were performed using the individual %s of sites with BL> 15%.
Based on the present findings, we conclude that type 1 DM has a modifying effect on marginal loss of alveolar bone. A clear trend towards increased marginal bone loss was seen in the subjects with complicated DM (D3). The subjects with good metabolic control and no complications of DM (D1) are no more susceptible to marginal bone loss than non-diabetic controls of the same age.
The present findings confirm our previous results on increased loss of periodontal support in subjects with complicated DM already at an early age.
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